Rachel M. Taylor

Background: With this study, we aimed to investigate the longitudinal relationships between lifestyle behaviors and physical health in childhood, adolescent, or young adult (CAYA) cancer survivors attending the Long‐Term Survivor's Clinic (LTSC) in Calgary, Canada. Methods: Survivors attended the LTSC once or twice a year and completed a questionnaire at each visit. Among survivors of any cancer diagnosis who were aged ≥ 11 years at the time of assessment, physical health was captured using two outcomes: the number of self‐reported physical health problems and the number of physical health‐related medications used. Self‐reported lifestyle behaviors, including physical activity, alcohol, tobacco, and cannabis use, and sleep quality were scored as healthy (1) or unhealthy (0), and combined into a sum score ranging from 0 to 5. Multivariable, generalized linear mixed models (GLMM) were estimated to assess the association between lifestyle behaviors (sum score and individual behaviors) and physical health outcomes, irrespective of time. To address our second research question, cross‐lagged GLMMs, incorporating a time component, were estimated to assess directionality between lifestyle sum score and the number of physical health problems. Results: In total, 766 responses from 312 CAYA cancer survivors (median age at follow‐up 23.8 years; 49% male; 37% diagnosed with leukemia) were included. A healthier lifestyle sum score and sufficient physical activity were associated with fewer physical health problems (estimate −0.15, SE 0.06, p ‐value 0.02 and estimate −0.23, SE 0.11, p ‐value 0.04, respectively). No significant associations were found between lifestyle and the number of medications used. Lifestyle behaviors at an earlier time did not predict better physical health at a later time and vice versa. Conclusions: Findings confirm an association between a healthy lifestyle and fewer physical health problems. Additional studies are warranted to further elucidate directional pathways between a survivor's lifestyle and physical health.

Introduction: Childhood cancer survivors (CCS) are at lifelong risk for late adverse health outcomes. Healthy behaviors, including physical activity, substance avoidance, adequate sleep, and sun protection, are critical to mitigating these risks. Yet, data on their prevalence and determinants in this population remain limited. This study aims to describe health behaviors among adolescent and young adult (AYA) CCS in Alberta, Canada, compare them with population‐based controls, and identify associated factors for suboptimal health behaviors. Methods: This is a longitudinal cohort study of 312 CCS aged ≥ 11 years enrolled in the Long‐Term Survivor Clinic at the Alberta Children's Hospital between July 2021 and July 2025. Self‐reported questionnaires captured health behavior outcomes and covariates. Comparisons were made with Canadian Community Health Survey (CCHS) controls. Risk factors were determined using Bayesian analyses. Results: Among 312 participants (median age 22.1 years [interquartile range 8.78]; 50.6% female) at baseline, 31% did not meet physical activity recommendations, 13% reported current tobacco use, 29% reported current cannabis use, 0.1% reported poor sleep quality, and 47% reported only sometimes or rarely using sunscreen, with 14% never using sunscreen. Only 5.8% reported ever using artificial tanning devices. Compared with controls, CCS had higher rates of insufficient physical activity and e‐cigarette use but lower rates of alcohol and medicinal cannabis use. Older age predicted artificial tanning, while male sex was associated with tobacco use and lower sunscreen adherence. Treatment intensity was not associated with any of the health behaviors. Conclusion: In this study, age and sex rather than treatment intensity predicted health behaviors. Emerging behaviors, such as e‐cigarette and medicinal cannabis use, highlight gaps in current survivorship care and the need for standardized counseling frameworks. Overall, the integration of routine health behavior assessments and targeted interventions addressing these behaviors and associated factors is warranted to optimize long‐term AYA survivorship outcomes.